Clin Orthop Surg.  2014 Sep;6(3):350-357. 10.4055/cios.2014.6.3.350.

Preoperative Nutritional Status of the Surgical Patients in Jeju

• Moon MS
• Kim SS
• Lee SY
• Jeon DJ
• Yoon MG
• Kim SS
• Moon H

• KMID: 1794719
• DOI: http://doi.org/10.4055/cios.2014.6.3.350

Abstract

BACKGROUND
To assess the preoperative nutritional status of patients with various disorders and to provide data for pre- and postoperative patient management plans, particularly in the elderly. There is no published information on age-matched and disease-matched preoperative nutritional/immunologic status for orthopedic patients, especially in the elderly, in Jeju.
METHODS
In total, 331 patients with four categories of orthopedic conditions were assessed: 92 elective surgery patients, 59 arthroplasty patients, 145 patients with fractures, and 35 infection patients. Malnutrition was defined as body mass index (BMI) below 18 kg/m2 of expected body weight (below 20% of normal), serum albumin/globulin ratio below 1.5 (normal range, 1.5 to 2.3), albumin level below 3.5 g/dL, total lymphocyte count below 1,500 cells/mm3, and lymphocyte/monocyte ratio below 5 versus 1.
RESULTS
In 92 elective surgery patients, the average BMI was 23 kg/m2, hemoglobin was 15 g/dL, lymphocytes (2,486 cells)/monocytes (465 cells) ratio was 6.1, and the albumin (4.4 g/dL)/globulin (2.5 g/dL) ratio as a protein quotient was 1.7. Among the 59 hip and knee arthroplasty patients, the average BMI was 25 kg/m2, hemoglobin was 12 g/dL, lymphocytes (2,038 cells)/monocytes (391 cells) ratio was 6.6, and albumin (4.1 g/dL)/globulin (2.4 g/dL) ratio was 1.6. No subject showed malnutrition. Among the 145 fracture patients, the average BMI was 23 kg/m2. The hemoglobin level was 13 g/dL, monocytes (495 cells)/lymphocytes (1,905 cells) ratio was 1 versus 4.6, and albumin (4.1 d/gL)/globulin (2.5 d/gL) ratio was 1.6. However, both ratios decreased after 70 years of age. Among the 17 of 35 infection patients, albumin levels were below 3.5 g/dL, the average BMI was 22 kg/m2, lymphocytes (1,532 cells)/monocytes (545 cells) ratio was 2.4 versus 1, and albumin (3.0 g/dL)/globulin (3.3 g/dL) ratio was 0.9, while in 18 patients albumin levels were over 3.5 g/dL, the average BMI was 22 kg/m2, hemoglobin was 12 g/dL, lymphocytes (1,998 cells)/monocytes (583 cells) ratio was 3 versus 1, and albumin/globulin ratio was 1.4. Thus, in the infection group, approximately 50% of the patients showed poor nutrition and immunosuppression.
CONCLUSIONS
It was found that nutritional and immune condition deteriorated gradually to some degree in elderly patients over 60 years of age.

Keyword

Nutrition; Preoperative; Surgical conditions; Age

MeSH Terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Body Mass Index
Body Size
Child
Humans
Malnutrition/blood/complications/*diagnosis
Middle Aged
Musculoskeletal Diseases/complications/*surgery
*Nutritional Status
Preoperative Period
Republic of Korea
Young Adult

Figure

• 

  Fig. 1 Survey chart for preoperative age-matched nutritional status of the surgical patients.

Reference

1. Dreblow DM, Anderson CF, Moxness K. Nutritional assessment of orthopedic patients. Mayo Clin Proc. 1981; 56(1):51–54.

2. Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ. Nutrition in orthopaedic surgery. J Bone Joint Surg Am. 1982; 64(9):1263–1272.

3. Sage R, Doyle D. Surgical treatment of diabetic foot ulcers: a review of forty-eight cases. J Foot Surg. 1984; 23(2):102–111.

4. Smith TK. Prevention of complications in orthopedic surgery secondary to nutritional depletion. Clin Orthop Relat Res. 1987; (222):91–97.

5. Sage RA. Diabetic ulcers: evaluation and management. Clin Podiatr Med Surg. 1987; 4(2):383–393.

6. Dickhaut SC, DeLee JC, Page CP. Nutritional status: importance in predicting wound-healing after amputation. J Bone Joint Surg Am. 1984; 66(1):71–75.

7. Harris WH, Sledge CB. Total hip and total knee replacement (1). N Engl J Med. 1990; 323(11):725–731.

8. Patterson BM, Cornell CN, Carbone B, Levine B, Chapman D. Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Joint Surg Am. 1992; 74(2):251–260.

9. Del Savio GC, Zelicof SB, Wexler LM, et al. Preoperative nutritional status and outcome of elective total hip replacement. Clin Orthop Relat Res. 1996; (326):153–161.

10. Gherini S, Vaughn BK, Lombardi AV Jr, Mallory TH. Delayed wound healing and nutritional deficiencies after total hip arthroplasty. Clin Orthop Relat Res. 1993; (293):188–195.

11. Nikolaus T, Bach M, Siezen S, Volkert D, Oster P, Schlierf G. Assessment of nutritional risk in the elderly. Ann Nutr Metab. 1995; 39(6):340–345.

12. Lesourd B, Mazari L. Nutrition and immunity in the elderly. Proc Nutr Soc. 1999; 58(3):685–695.

13. Koval KJ, Maurer SG, Su ET, Aharonoff GB, Zuckerman JD. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma. 1999; 13(3):164–169.

14. Parker MJ, Gurusamy K, Stoker M. Surgery in elderly patients. Curr Orthop. 2004; 18(5):333–344.

15. Eneroth M, Olsson UB, Thorngren KG. Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res. 2006; 451:212–217.

16. Takahashi J, Shono Y, Hirabayashi H, et al. Usefulness of white blood cell differential for early diagnosis of surgical wound infection following spinal instrumentation surgery. Spine (Phila Pa 1976). 2006; 31(9):1020–1025.

17. Porrata LF, Ristow K, Colgan JP, et al. Peripheral blood lymphocyte/monocyte ratio at diagnosis and survival in classical Hodgkin's lymphoma. Haematologica. 2012; 97(2):262–269.